Evaluation of Gingival Crevicular Fluid Alkaline Phosphatase in Postmenopausal Women Treated With Subgingival Simvastatin

Abstract

BACKGROUND Women at menopause are found to be at risk for decreased bone density and chronic periodontitis due to oestrogen deficiency and common risk factors. Statins have anti-inflammatory and anti-resorptive properties and are successfully used in postmenopausal osteopenia. Increased alkaline phosphatase activity is observed in periodontitis. Thus, 1.2 mg Simvastatin gel was used subgingivally in this study. The level of alkaline phosphatase was evaluated in the sites treated as a biomarker. MATERIALS AND METHODS 20 systemically healthy postmenopausal subjects were sampled. Two bilateral pockets (≥ 4 mm) in each subject were randomised. After phase I therapy, the selected sites were randomised as either site A or site B. The sites received either 1.2 mg Simvastatin insitu gel or a placebo gel. An assessment of the probing depth and clinical attachment level was made on the baseline and at 3 months interval. Gingival crevicular fluid was tested for alkaline phosphatase levels on baseline, 14th day and 90th day post-operatively. Statistical analysis included descriptives, repeated measure ANOVA, Wilks' Lamdba, paired and independent sample t-test. RESULTS The test and control sites demonstrated improvements in clinical parameters, which was statistically significant (p < 0.05). Further, the test sites showed statistically significant improvement over the control sites. A significant decrease in GCF alkaline phosphatase levels was observed in both test and control sites after 14 days. However, the test sites showed significantly higher values than control sites. Although not significant, the alkaline phosphatase levels further decreased in test sites when evaluated after 90 days. CONCLUSION The use of simvastatin in-situ gel in periodontal pockets showed satisfactory clinical improvement owing to its prolonged antiinflammatory property. It can be a promising adjunct to conventional protocols employed in management of periodontal disease in postmenopausal subjects.